Specific Aspects of Preterm CareAddressed by Other Speakers Organization of care Schunko, Stark, Stranak, Ognean, Sydorov, Tkachenko, Chernov Resuscitation and stabilization Stranak, Dobryanskiy Early intervention Curteanu
Specific Aspects of Preterm CareAddressed by Other Speakers Noninvasive and high-frequency ventilation Marozsynska Ethical issues Opitz Neuroprotection Baud Anemia and transfusion Bell
Specific Aspects of Preterm CareAddressed by Other Speakers Bronchopulmonary dysplasia Rubenstein Jaundice Stark Nutrition Ziegler Ductus arteriosus Schirtz
Other Specific Aspects of Care of theExtremely Preterm Infant Thermal care Intracranial hemorrhage Apnea of prematurity Infection Necrotizing enterocolitis Retinopathy of prematurity
Definitions Full-term: > 37 weeks 87.9% Preterm: < 37 weeks 12.1% Very Preterm: < 32 weeks 2.0% Extremely Preterm: < 28 weeks 0.7% Approximately 3500 per year in Ukraine
The Influence of the Thermal Environment uponthe Survival of Newly Born Premature InfantsW. A. Silverman, J. W. Fertig, A. P. Berger Survival rate Birth weight range (g) 28 oC 32 oC < 1000 14% 50% 1001-1500 77% 86% 1501-2500 79% 93% PEDIATRICS, November 1958
Intracranial Hemorrhage and Periventricular Leukomalacia Periventricular Intraventricular IVH at postmortem leukomalaciahemorrhage (IVH) on ultrasound
Intracranial Hemorrhage Prevention Prevent preterm birth Antenatal corticosteroids to mother Vitamin E at birth Avoid blood pressure fluctuations, pneumothorax, high and low PCO2 Correct coagulation disorder Treatment Nothing for hemorrhage itself, but posthemorrhagic hydrocephalus can be treated
Apnea of Prematurity Prevention Prevent preterm birth Treatment First, rule out underlying cause, such as atelectasis or infection, and treat cause If it is true apnea, what is the predominant type of apnea – central or obstructive? If central, treat with caffeine, theophylline, or aminophylline If obstructive, consider CPAP
Infection Prevention Mother should be immunized against hepatitis, tetanus, rubella, and possibly tuberculosis Careful infection control practices, including meticulous hand hygiene (will be discussed by Dr. Schlösser) Limit use of foreign bodies that enter the body, such as intravenous cannulae and endotracheal tubes, and remove these when they are no longer needed Treatment Appropriate, focused antibiotics
Retinopathy of Prematurity Prevention Prevent preterm birth Antenatal corticosteroids to mother Careful monitoring of oxygen therapy Before 32 weeks postmenstrual age, keep oxygen saturation 90-95% Retinal examinations by qualified ophthalmologist Treatment After 32 weeks postmenstrual age, if infant has ROP, keep oxygen saturation in the mid to high 90s Laser ablation
Success Brings New Challenges As you experience more success in reducing mortality of extremely preterm infants, you will see more patients with these complications Hypothermia Intracranial hemorrhage Apnea of prematurity Infection Necrotizing enterocolitis Retinopathy of prematurity
Jeff Hackbarth, 24 weeks gestation, 690 grams, university graduate
A particular slide catching your eye?
Clipping is a handy way to collect important slides you want to go back to later.